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Why a Covid Vaccine Mandate for N.Y.C. Schoolchildren Is Unlikely Soon

Teachers at New York City public schools are required to be vaccinated against Covid-19. Children involved in after-school activities that have a higher risk of spreading the virus — including many sports, as well as chorus and band — must be vaccinated, too.

But while New York City Mayor Eric Adams and New York Gov. Kathy Hochul have both said they support making Covid vaccination for all public school children mandatory, that does not necessarily mean it is happening soon.

Momentum on the issue, both in New York and across the country, has stalled, lawmakers and experts say.

In part, this is because the F.D.A. has not yet granted full approval to a Covid-19 vaccine for children under 16. Another problem is the disappointing efficacy of the current Pfizer vaccine against preventing infection in children under 12. (The F.D.A. has granted emergency authorization for children 5 to 16.)

Mr. Adams could decide on his own to make Covid vaccination mandatory for the city’s public school children, even if the state balks. But he has not been eager to impose new virus mandates of any sort since taking office in January. The result is that as the end of this school year approaches, it is looking unlikely that Covid vaccines for New York City public school children will be mandated for their return to school next fall.

Here are five reasons why:

The state is unlikely to pass a bill soon.

For the Covid-19 vaccine to join the list of 12 other vaccinations required by state law for school attendance, the New York State Legislature would have to vote to amend the current public health law.

Democratic lawmakers have introduced bills in both the Assembly and the Senate to do this, but acknowledge there is insufficient momentum to move forward.

Senator Brad Hoylman, who introduced the childhood Covid vaccine bill into the Senate last October, said his bill was such a hot potato it had not even been assigned a formal bill number. “Clearly an indication that it is not ready to be considered,” he said.

When the Legislature passed a 2019 law that removed religious exemptions for childhood vaccines, a flood of impassioned anti-vaccine activists protested at the capitol and outside some lawmakers’ homes and offices.

“I think there is still PTSD on behalf of some of my colleagues,” Mr. Hoylman said.

Assemblyman Jeffrey Dinowitz, who introduced the Assembly’s version of the bill, expressed doubts that it would advance in the Legislature in the next few months unless the next wave of virus cases turned out to be more virulent.

The mayor has been vague on a timeline.

Even if the state doesn’t act, the mayor could. The courts have affirmed that New York City can mandate additional school-age vaccinations even without state action.

But in recent months, Mr. Adams has moved the city in the opposite direction, suspending a program that encouraged families to vaccinate their children by requiring vaccination to enter restaurants or indoor entertainment venues. On Monday, the mayor and New York City Department of Education announced they would lift the vaccine requirement to attend public school proms.

He has said repeatedly that he would back a mandate for schoolchildren once the vaccine is fully F.D.A.-approved for them, but the timeline for that is uncertain.

Pfizer asked the F.D.A. to fully approve its vaccine for 12-15 year olds in December, and a decision could come in the next few months. The company has not yet applied for full approval for 5 to 11 year olds.

On Friday, Mr. Adams said he would make a decision in the next few weeks. He added that his position on a mandate had not changed, but that he wanted his health team’s advice.

National momentum has faltered.

California was the first state to add the Covid-19 vaccine to its list of required vaccines for Fall 2022, for age groups with vaccines that have full F.D.A. approval. But California state officials recently announced they would delay implementation until July 2023, at the earliest. Los Angeles, which had originally set an even earlier deadline for its own student mandate, has delayed its rollout to match the state’s time frame.

This is in keeping with national trends, said Bree Dusseault, principal at the Center on Reinventing Public Education, which has been tracking Covid-19 policies at 100 large districts nationwide.

“Over the course of this year, very few districts have put student mandates in place,” she said. “And most of the ones that have them have actually pulled back dates and timelines, and really grappled with when and how to execute them.”

Besides California, only Louisiana has a statewide vaccine mandate for schoolchildren that will go into effect, pending F.D.A. approval. But parents can opt out if they have “any written objection,” according to the National Academy for State Health Policy, which tracks school vaccination policies nationwide. Washington, D.C. has also passed a mandate that is scheduled to take effect this fall.

The momentum for mandates was stronger last fall, but has lessened with Omicron, which showed a stronger ability to break though vaccine-acquired immunity. At this point, far more states have barred student Covid-19 vaccination mandates — 19 states — than have passed them.

Omicron weakened the public health argument.

One of the strongest public health arguments for mandating vaccination for schoolchildren is that preventing them from getting infected helps to protect vulnerable people at home. But in children ages 5 to 11, the Pfizer vaccine’s effectiveness against preventing infection during the December and January Omicron surge was just 12 percent, according to a study led by the New York State Department of Health.

The vaccine was more effective in older children and in preventing hospitalization, the study found.

“It’s disappointing, but not entirely surprising, given this is a vaccine developed in response to an earlier variant,” Eli Rosenberg, deputy director for science at the New York State Department of Health, who led the study, said in a February interview.

The federal government also recently estimated that 75 percent of the nation’s children and adolescents have already been infected by Covid-19, giving them at least some protection and bolstering arguments that mandates should wait until the vaccines or their dosages are recalibrated for newer variants.

Waiting might be more effective in the long run.

The American Academy of Pediatrics continues to recommend vaccination for all children and adolescents ages 5 and older, including for those were previously infected. But jumping from that to a mandate is a big step.

Several experts said it would be better to keep focusing on voluntary vaccination programs before next fall, particularly while the federal government is still mulling the vaccine’s full approval. Conversations could take place to address parent concerns about vaccine safety. And incentives could be offered.

Dr. Jennifer Nuzzo, the director of the Pandemic Center at Brown University School of Public Health, said that the Covid vaccination rate among children “has basically just flatlined.”

“One of the concerns I have is the desire to just fix something with mandates,” she added. “You can’t take shortcuts. We have to figure out why the uptake is what it is, and try to solve those issues, otherwise we will see backlash.”

Though it surpasses the national average, the vaccination rate among the city’s elementary-aged children still remains quite low. Citywide, 46 percent of children ages 5 to 12 are fully vaccinated, while 80 percent of children ages 13 to 17 are fully vaccinated. But these rates vary widely by both community and race, hinting at the deep challenge of enforcing a mandate.

For example, 99 percent of Asian children ages 5 to 12 in New York City are fully vaccinated, according to city statistics. But only 37 percent of the city’s white children ages 5 to 12 are. The vaccination rate for white children that age is strikingly different by borough, from 21 percent in Staten Island to 84 percent in Manhattan.

Pediatricians are also somewhat divided on the issue of a vaccine mandate, said Dr. Toni Eyssallenne, an internist and pediatrician for Strong Children’s Wellness, a Queens-based medical group.

A mandate will boost the vaccination rate, said Dr. Eyssallenne. But, she added, “since this is a relatively new vaccine, some parents might pull their children out of school or other activities that can positively influence development, socially and emotionally.”

Lola Fadulu, Emma G. Fitzsimmons and Joseph Goldstein contributed reporting.

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